̒Still Arguing Over Cost̓: Bargaining, Etiquette and the Modern Patient in Republican Beijing

Abstract

In this article I have endeavoured to show how conflicting notions of consumer etiquette and patient behaviour played out during negotiations between social workers and patients at Peking Union Medical College Hospital (PUMC) in the 1930s. Organisational technologies such as quantification, record keeping, statistics, standardisation and systematisation were essential aspects of the American-style scientific medicine that PUMC aimed to introduce to China in the Republican period. Chinese patients brought assumptions of their own to the American hospital, however. Wealthy women in particular insistently bargained over the price of treatment, thereby adopting a selective approach to hospital therapies. In response, hospital social workers, who were allowed considerable flexibility about the manner of negotiating prices, adapted payment customs to satisfy this class of patients. At the same time, social workers wielded their control over resources with an eye toward disciplining patients in various ways. They investigated patients' financial circumstances, gathering evidence in order to compel more truthful self-disclosure, or a posture of deference toward scientific and institutional authority. In Republican Beijing a 'modem' Chinese patient role thus evolved through a process of mutual, if asymmetrical, negotiation. Themes that become visible in the process of negotiating payment are suggestive of ways PUMC, as a model of administrative modernity and scientific organisation, was both linked to—and diverged from—consumer practices and concepts of distributive justice rooted in a distant society.